Impact of stress and psychosocial risks on health and performance- Evidence at the organizational level

Transcription

1 HWC Healthy Workplace Manage Stress Campaign Partnership Meeting Brussels, April Impact of stress and psychosocial risks on health and performance- Evidence at the organizational level Johannes Siegrist Senior Professor of Workstress Research University of Duesseldorf, Germany

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3 Main Questions Is stress at work a real challenge to working populations across Europe? What is the scientific evidence linking stress at work with adverse health? What can be done at organizational level to manage stress and improve health at work?

4 Importance of work for health Work provides a source of regular income and related opportunities provides a source of personal growth and training of capabilities/competencies provides social identity, social status and related rewards enables access to social networks beyond primary groups Impacts on personal health and well being by exposure to material and psychosocial stressors

5 Significant changes in the nature of work and labour market Increase of work pressure, pace of work,and competition, including high power work organization (impact of economic globalization) High demand for flexibility, mobility, and adaption of workers to new taks/technologies Fragmentation of occupational careers, de-standardized or atypical work, and growing job instability/insecurity Increase of service and IT professions/occupations with high psychomental/emotional workload Segmentation of labour market; social inequalities in quality of work and employment

6 Effects of economic globalisation: Labour market consequences in developed countries Increased pressure of rationalisation (mainly due to wage competition) Downsizing, Merging, Outsourcing Work Job Low wage / intensification insecurity salary

7 Increase in work intensity : European Social Survey, 19 EU countries Source: Gallie D (Ed.) (2013) ESS Topline Results Series 3, European Social Survey

8 Job insecurity European Social Survey, 19 EU countries Source: Gallie D (Ed.) (2013) ESS Topline Results Series 3, European Social Survey

9 2. Question: What is the scientific evidence linking stress at work with adverse health? Stress occurs if a person is exposed to a threatening demand (stressor) that taxes or exceeds her/his capacity of successful response risk of loss of control Dimensions of stress reactions: Cognitive appraisal (evaluation of threat) Affective response (anxiety, anger) Activation of stress axes in organism (SAM, HPA) Behavioural reaction (fight or flight) (restricted option!) Critical for health: Chronic stressors requiring active coping allostatic load; risk of stress-related disorders (depression, CHD)

10 Working conditions as chronic stressors: How to identify toxic components within complex environments? negative emotions stress-related disorders stress responses allostatic load

11 Chronic psychosocial stress at work: Complementary stress-theoretical models Demand-control model (R. Karasek, 1979; R. Karasek & T. Theorell, 1990) Effort-reward imbalance model (J. Siegrist, 1996; J. Siegrist et al., 2004) Organizational injustice model (J. Greenberg, 1990; M. Elovainio et al., 2002) Focus on job task profile: high demand/low control Focus on work contract: high effort/low reward Focus on unfair procedures and interactions

12 The demand-control model (R. Karasek 1979; R. Karasek & T. Theorell 1990) Quantitative demands Scope of decision/control low high low low distress passive high active high distress Psychometric scale of demand-control model:

13 The model of effort-reward imbalance (J. Siegrist 1996) Extrinsic components demands / obligations effort - labour income - career mobility / job security - esteem, respect reward motivation ( overcommitment ) motivation ( overcommitment ) Intrinsic component Psychometric scale of effort-reward model:

14 Mean level of work stress in 17 European countries (SHARE, ELSA, n = , aged 50-64) Psychosocial Working Conditions Switzerland Sweden Netherlands Denmark Belgium Austria Germany France Spain England Slovenia Estonia Italy Poland Czechia Portugal Hungary Mean ERI Denmark Sweden Netherlands Switzerland Portugal Slovenia Belgium Germany France England Estonia Austria Spain Czechia Italy Hungary Poland Mean Low Control Source: T. Lunau et al. (2013): Unpublished results

15 The social gradient of work stress in the European workforce (age 50-64): SHARE-study Social gradient of work stress Percent high stressed Very low Low Medium High Very high 5 0 Effort-Reward Imbalance Low control Source: Wahrendorf M et al. (2013) European Sociological Review 29:

16 Scientific evidence from prospective cohort studies: Demand-control and effort-reward-imbalance models Depression: ~ 30 studies (Europe, USA, Canada, Japan): People exposed to stress at work: mean increase of relative risk: 80% = OR 1.8 (95% CI ) Coronary heart disease: ~ 20 studies (Europe, USA): People exposed to stress at work: mean increase of relative. risk: 40% = OR: 1.4 (95% CI ) Additional evidence of elevated health risks: Metabolic syndrome / type II diabetes Alcohol dependence Musculoskeletal disorders Source: Steptoe A, Kivimäki M Nat Rev Cardiol.9 ; Stansfeld SA,Candy B 2006 Scand J WEH 32: 443

17 Work stress and cardiovascular mortality: Finnish Cohort Study, n = 812 employees 2,5 2 * * Tertile (work stress): 1 = no 2 = low 3 = high Hazard ratio # 1,5 1 0, High demand / low control High effort / low reward # adj. for age, sex, SEP, smoking, phys. act., SBP, cholest., and BMI Source: Based on Kivimäki, M, et al. (2002), BMJ, 325: 857, doi:/ /bmj

18 Psychosocial stress at work and depressive symptoms: employed men and women yrs. from 17 countries in three continents (SHARE, ELSA, HRS, JSTAR) 2,5 * * 2 * 1,5 1 * * ERI Low control 0,5 0 USA (N=1560) Europa (N=10342) Japan (N=1226) Source: J. Siegrist et al (2012) Globalization and Health 8:27.

19 3. Question: What can be done at organizational level to manage stress and improve healthy work? Provide evidence of a business case Provide shared commitment from management and employees Provide available expertise (e.g. occupational safety & health) and equipment Monitor working conditions and employees health Develop and implement programmes, invest in improvements, consult models of best practice Ensure continuity, evaluate outcomes, build networks

20 Develop and implement Healthy Workplace Programs Personal level: Stress prevention programs Interpersonal level: Leadership training; communication skills; Structural level: Organizational/personnel development (based on work stress models) Job enrichment/ enlargement (autonomy, control, responsibility) Skill utilization / active learning Participation / team work and social support Culture of recognition Fair wages/ gain-sharing Continued qualification/ promotion prospects

21 Personal level: Effects of worksite stress prevention programs: Meta-analysis Source: D Montano et al. (2014) Scand J Work Environ Health, doi: /sjweh.3412.

22 Interpersonal level: Leadership training of managers and stress hormone excretion in subordinates Intervention group Baseline After 1 year Control group Baseline After 1 year Mean Cortisol (nmol/l) * Mean decision latitude (range 2-8) ** Interaction group X time: *p =.05, **p =.02 Source: T. Theorell et al. (2001), Psychosom Med, 63:

23 Structural level: Organizational intervention in a Canadian hospital vs. control hospital* Variable Means at t2 adj. for t0 experimental - control hospital p Demand Control Social support Reward Effort-reward imbal Work-rel. burnout *36 month-follow-up, two Canadian hospitals, N=248 (intervention) vs. 240 (control hospital) (ANCOVA, adj. for baseline values) Source: R. Bourbonnais et al. (2011), Occup Environ Med, 68:

24 Seven practices of successful organizations: Reconciling health promotion with economy! 1. Employment security 2. Selective hiring of new personnel 3. Self-managed teams; decentralization of decision making 4. Comparatively high compensation contingent on performance 5. Extensive training 6. Reduced status distinctions and barriers 7. Extensive sharing of financial and performance information

25 The Sirdal Model of Improved Work Productivity and quality of outcomes Client satisfaction Investments into good quality of work Workplace/-environment Health and wellbeing of employees

26 Thank you!